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Lawyers in Alleged Diluted Drug Case Speak

A wealthy Kansas City pharmacist has been arraigned and detained on charges of diluting drugs, sometimes dispensing only 1% of the medication prescribed.

Federal investigators claim Robert R. Courtney dispensed hundreds of prescriptions for end-stage chemotherapy treatments. The FBI and the FDA are continuing to investigate but rushed to indict the pharmacist because of the public safety risk.

Courtney was charged Tuesday with a single felony count of misbranding and adulteration of a drug and was ordered held without bond on Wednesday by a judge who called him a flight risk.

Robert Courtney is accused of diluting prescriptions for Taxol and Gemzar that were filled at his Research Medical Tower Pharmacy in Kansas City. In one alleged case, dilution would have saved the pharmacy about $780 for an order of drugs.

Jean Paul Bradshaw, Courtney's defense attorney and a former US attorney, had these things to say during an interview with the Early Show:

A lot of the interest of the case has to do with what cancer patients have to fear. We are dealing with a smaller time frame and a fewer number of patients than people think. Maybe 50 patients over 3 or 4 months, and only one or two doctors’ prescriptions were filled. We don’t believe that the group of oncologists across the hall received the drugs in question.

No one has raised the questions about other people who work there, or any other drug prescriptions. The government hasn’t alleged any widespread situation. It is a narrow case, not a generalized problem.

The charge Mr. Courtney faces is a lighter federal felony, an FDA violation relating to mislabeled and adulterated drugs. It is possible that they could amend the charges to include more. But it is hard to prove that someone who is already sick with a fatal disease was murdered from conduct that may have resulted from injury or death.

We will plead not guilty on Monday.

Patrick McInerney, of Blackwell Sanders, LLP, also spoke with the Early Show. McInerney is an attorney who represents a group of oncologists who used the pharmacy that was located directly across the hall from Robert R. Courtney.

How did you find out about this?

Kansas City Internal Medicine (aka "KCIM") includes a group of doctors who practice oncology. They provide chemotherapy treatment that involves injections into the body to kill cancer cells.

Research Tower Pharmacy is right across the hall from his clients’ doctors’ office. The medications were mixed on site by Tower Pharmacy. This is common practice and the medications must be used quickly after they are compounded. It was a close relationship. The chemotherapy medications would be walked across the hall soon after they had been ordered. KCIM was notified a couple of days ago about the investigation and the immediate response was shock. The first concern was the patients, so a process immediately bega to identify those who had been administered these medications.

How many doctors are in KCIM?

Now there are two oncologists, but in the last year there have been more than five doctors at KCIM. They have treated hundreds of chemotherapy patients with end-stage drugs, used when other approaches have failed.

How long has this been going on?

We are still trying to get our arms around the size and scope because the investigation is still ongoing.

Who started this investigation?

There was a pharmaceutical representative who was talking to someone in the pharmacy. Someone commented to the representative that the pharmaceutical company must have had a good year because they billed doctors over $1 million.

When the representative brought this information back to his boss, the boss clearly said that this was not possible because they had only supplied a fraction of that to the pharmacy.

Could this have been prevented?

Thre was no indication that there was something wrong with the patients because these medications are used in end-stage patients with high mortality rates.

Indications of the drug being diluted, such as the absence of side effects, would have gone undetected. The patients are given anti-side-effect medication in addition to the chemotherapy medication.

What can patients do if they have been given the diluted drug?

It varies patient by patient. We are talking to all of the patients in the practice, offering every service.

What are the drugs used and what part do they play in curing cancer?

These drugs are chemotherapy drugs: They attack specific cells in the body.

The FBI is involved. Judy Lewis is the supervisory special agent of the investigation

How did you learn of the crime?

A physician brought to their attention the fact that Tower’s drug seemed to be of a lesser strength than was prescribed. An investigation was initiated with the FDA on July 27th.

Of the dosages prescribed, the high was 34% and the low was 17%. The physician then purchased more drugs from the pharmacy and the FDA lab came back with a high of 35% and a low less than 1%.

When this was done again, a search warrant was obtained from the US Attorney’s office that was executed on Monday. A criminal complaint was filed against Courtney, who surrendered on Wednesday. A bond hearing will be held on Monday.

Why is this a federal issue?

The FBI was called in because the states would have no statutes to deal with this. On a federal level, there is the Healthcare Fraud Statute. This is a healthcare crime. Punishment is 20 years.

But we want to complete our investigation and decide what the ramifications of his activities are.

Could he be charged with murder or manslaughter?

We have no indication that murder is involved. If they could link his activity to someone’s premature deat, he would be charged accordingly.

From what you've seen so far, approximate how many people could be involved?

His pharmacy has been in existence for 20 years or so. But we don’t have a clear understanding of his business practices or how much of the drugs he sold.

Have you contacted any people?

We have a hotline set up. Some of those people have been contacted. We ask them questions about their treatment and recommend that they talk to their lawyers.

What is their recourse?

I suppose they would have civil remedies.

Though the pharmacist was undermedicating the patients, was he giving them enough medicine to be effective?

It is against the law to send a drug out with the wrong label. Courtney told doctors they were getting a certain amount, the amount they prescribed, when he was actually giving them much less.

Do you have concerns about the other pharmacist who worked with Courtney?

He is the only one being charged right now.

Are you concerned other drugs may have been diluted?

We are only looking at Taxol and Gemzar.

Is the pharmacy open for business?

Yes the pharmacy is open and they are doing business. We didn’t execute a warranty at his other pharmacy.
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